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Kate’s Classes > NOLS: Problems > Flashcards

NOLS: Problems Flashcards

1
Q

Blister

A

Tx: Hypafix toes to prevent; burn-pad donut existing blisters. Lance low

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2
Q

Subungal Hematoma

A

Tx: heat needle, push through nailbed.

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3
Q

Wound

A

Tx
1: direct pressure 3 min w/fingertips
2: pressure dressing bulky gauze+compression

Evacuate: can’t be cleaned/closed, not healing, involves a joint/tendon/ligament, animal bite, crushing, face, impalement, amputation or infection.

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4
Q

Dislocation

A

S/S: joint doesn’t look right

Tx: PAS + TIL

Evacuate: if it’s the first time. Rapid evacuation if decrease in CSM

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5
Q

Dislocation: Jaw

A

Tx
1: dresser drawer. Massage first
2: gauze around thumbs
3: thumbs on back molars
4: weight arms
5: ace wrap to support

(Good source: https://www.theadventuremedic.com/dental/am-guide-to-managing-jaw-dislocation-on-expedition/)

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6
Q

Dislocation: Fingers/Toes

A

Tx: do not reduce at webbing.

Others
1: pull with 10-15 lbs of pressure
2: buddy tape. Spoon works well

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7
Q

Dislocation: Shoulder

A

S/S: Dip in one shoulder; anterior to front; posterior to back (can cause more damage).

Tx: Coker method or Simpson, which is easier and effective:

1: lay on table with arm hanging
2: hang 3 Nalgene from bicep, gradually
3: massage scapula.
Steps 2-3 could take up to 30 minutes. Once reduction succeeds (normal look, less pain, motion) then:

4: sling & swath

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8
Q

Dislocation: Patella

A

Often to outside/lateral

Tx
1: Light quad massage
2: Hold patella and guide it back towards center as you straighten the leg.

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9
Q

Fracture

A

S/S: visibly out-of-place, intense pain, inability to weight, bone is sticking out

Tx
1: Pain meds
2: Clean/irrigate
3: TIL or Pack & Dress
4: Splint

Splint
1: immobolize above and below
2: Padding + rigidity
3: keep it svelt
4: maintain access to CSM

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10
Q

Spine Injury

A

MOI
1: velocity+sudden stop
2: fall above 3 ft on butt/head
3: fall by someone 65+
4: head trauma+ △LOR

Assume if unresponsive

Croissants at 7 (cervical)
Tacos at 12 (thoracic)
Lasagna at 5 (Lumbar)

S/S: pain, numbness/tingling, weakness/paralysis, s/s shock, bowel/bladder, respiratory distress

Tx
1: protect spine
2: monitor CSMs & Vitals
3: comfort
4: evacuate

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11
Q

Head Injury, Mild

A

S/S: △LOR, headache

Tx: rest, monitor

Evac: if no improvement w/in 24h

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12
Q

Head Injury, Serious/Fracture

A

S/S: △LOR, combative, vomiting, HR bounds, RR erratic, BP rises, skin flushed, pupils unequal

Tx: manage ABC, rest on side, elevate head, EVACUATE

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13
Q

Neurological, Seizure

A

MOI: Alone, epilepsy, heat stroke, HACE, head injury, low blood sugar, low blood sodium

S/S: Starring, Jerking limbs, lose of bowels/bladder control

Tx: no restraint, recovery position, PAS, protect dignity

Evac: if first, associated with injury or illness

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14
Q

Neurological, Stroke

A

MOI: Interruption of blood to the brain.
TIA: transient ischemic attack <24hr.
CVA: cerebrovascular accident/full stroke.

S/S: sudden severe headache, memory loss, change in speech, one-sided paralysis.

FAST Test: face unequal, arms imbalanced, speech slurred/processing. Time to Go

Tx: fast test, note start time, position of comfort, keep calm, rapid Evac.

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15
Q

Neurological, headache

A

Evac:
S/S are suddenly or severe
don’t improve with treatment
Paired with altered mental state

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16
Q

Neurological, Syncope

A

MOI: fainting, often drop in BP

S/S: dizzy, vision change, light-headed

Tx: lay flat, elevate legs, PAS for residual S/S

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17
Q

Neurological, unresponsive

A

Talk to them, full PAS, check phone/wrist/neck/pockets

What stops the brain?
T: toxins
S: sugar, seizure, stroke
T: temperature
O: oxygen
P: pressure

Tx: recovery position, sugar on the gums, monitor LOR, consider Evac

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18
Q

Neurological, Opioid overdose

A

MOI: suppression of central nervous system CNS, leading to repression of breath

Tx: Narcan, rescue breaths, recovery position

19
Q

Shock

A

MOI: Inadequate delivery of oxygenated blood (perfusion) to the tissues and organs of the body. 3 types:
1: Hypovolemic (fluid loss)
2: Cariogenic (heart failure)
3: Vasogenic (spine injury or anaphylaxis)

S/S: ↑RR + ↑HR + Skin Cool/Pale/Clammy = assume shock

S/S Compensatory: early. Nausea, vomiting, anxious

S/S Decompensatory: ↑RR + ↑HR +↓BP + Skin bluing + △LOR

Rx: Treat cause, manage ABC/body temp/liquids. Keep calm. Elevate feet. Evacuate.

20
Q

Mental Health

A

Anxiety S/S: SPCC, ↑RR, ↑HR, Dizzy, Chest tightness or pain

Suicidal: Thoughts? Plan? Means? Time? History?

Rx: Be calm, PAS to rule out physical cause, listen, be honest, beware touch

21
Q

Diabetes: Hypoglycemia

A

*Never give Insulin. When in doubt, Give sugar.

MOI: Too little sugar in the blood.

S/S: Fast onset, △LOR, ↑HR, SPCC, Blood sugar<80mg/dl

Rx: Check blood sugar. Offer simple sugar → larger meal

22
Q

Diabetes: Hyperglycemia

A
  • Never give Insulin. When in doubt, Give sugar.

MOI: Too much sugar + not enough insulin

S/S: Slow onset,↑thirst/hunger/urine, fatigue, ↑RR, Sweet/alcohol breath, → Late LOR “drunken”, Blood sugar > 120mg/dl

Rx: if doubt, give sugar. Hydrate. Consider Evacuation

23
Q

Cold: Hypothermia, Mild

A

S/S: Shivering, cold, apathy, “umbles”

Rx: Move, get warm & dry, hot sweet drinks

24
Q

Cold: Hypothermia, moderate

A

S/S uncontrollable shivers + “Umbles” + unstable LOR

Tx: As for mild + HypoWrap + sit-ups

25
Q

Cold: Hypothermia Severe

A

S/S: no shivering, rigid, unresponsive, HR hard to find

Rx: Move gently. HypoWrap, evacuate. Monitor for sudden ↓BP upon rewarming

26
Q

Cold: Frostbite

A

S/S: wooden/waxy skin, blisters, mottled skin

Rx: Don’t rub. Skin-to-skin rewarming. ±100 H2o. Dry+elevate. Evacuate.

27
Q

Heat: Exhaustion

A

S/S: nausea, cramps, SPCC, dizzy

Rx: rest, cool down, observe

28
Q

Heat: Stroke

A

S/S: nausea, cramps, dizzy + △LOR, skin red/hot, stumbling

Rx: Cool aggressively. Evacuate

29
Q

Hydration: Dehydration

A

S/S: Thirst, dark urine, S/S shock, diarrhea

Tx: drink small sips

30
Q

Hydration: Hyponatremia

A

S/S: Nausea, vomiting, headache. Late: △LOR

Tx: no more water. Salty snack, No saline IV

31
Q

Hydration: Rhabdo

A

Rhabdomyolysis is the breakdown of muscle tissue that releases a damaging protein into the blood. Damages organs. Rare. Effects endurance athletes, firefighters.

S/S: Severe muscle pain, fatigue, cola urine

Tx: Hydrate. Evacuate.

32
Q

Altitude: AMI

A

Acute Mountain Illness

S/S: Headache, nausea, vomiting, anorexia, insomnia
Tx: hold elevation, eat, light exercise
Rx: 125 mg acetazolamide/Diamox every 12 hrs

33
Q

Altitude: HACE

A

High Altitude Cerebral Edema. Deadly, less common.

S/S: Ataxia is key. Disoriented, irritable, combative. Headache. △Vision, △LOR → Late: unresponsive.

Tx: Rapid decent. Request o2 + hyperbaric/Gamow bag

Rx: 8 mg Dexamethasone + 4 mg/6hr during evac

34
Q

Altitude: HAPE

A

High Altitude Pulmonary Endema. Biggest Killer.

S/S: Shortness of breath, dry cough. → wet pink cough + trouble laying back.

Tx: Rapid decent. Request o2 + hyperbaric/Gamow bag

Tx: Albuterol used to be recommended. Not helpful. Not harmful.

35
Q

Guts: Gastroenteritis

A

MOI: bacteria or Protozoa

S/S: Nausea, Vomiting, Diarrhea

Rx: Hydrate/electrolytes, bland food, anti-diarrheals, antibiotics.

Evac: Consult Evac Criteria for Gut pain

36
Q

Guts: Organs by Quadrant

A

R Upper: Liver, R. Kidney, Gallbladder, Pancreas, Colon
L Upper: Liver, L. Kidney, Spleen, Pancreas, Colon, Stomach
R Lower: Colon, Sm. Intestine, Appendix
L Lower: Colon Sm. Intestine

37
Q

Guts: Evacuation

A

Evacuate if: pain inconsistent w/UTI or GI, worsening gastroenteritis>24hr, pregnant, fever, can’t eat/drink

Rapid Evacuation if: 12hr constant/worsening, distensión/rigidity/guarding, foot strike test, blood in urin/vomit/poop, fever>102, S/S shock

38
Q

Guts: PAS

A

Sample History first if medical issue: N/V, diarrhea/constipation, blood in vomit/urine/poop, pain, period/stress/history

Head-Toe: pain on palpation or release of palpation, rigidity, guarding, distention, bruising/wounds, pain on footstrike

V/S: △LOR, ↑RR +↑HR, SPCC,↑BP

39
Q

Allergies: Mild

A

S/S: swelling, flushed, hives, no breathing issues

TRX: 4 Benadryl + monitor for facial swelling/breathing issues

40
Q

Allergies: Anaphylaxis

A

S/S: Breathing distress OR Airway swelling, G/I, S/S shock

Tx: Epinephrine, antihistamines + evacuation

41
Q

Respiratory & Cardiac: Unconscience

A

Talk to them, full PAS, check phone/wrist/neck/pockets

What stops the brain?
T: toxins
S: sugar, seizure, stroke
T: temperature
O: oxygen
P: pressure

Tx: recovery position, sugar on the gums, monitor LOR, consider Evac

42
Q

Respiratory & Cardiac: Hyperventilation

A

S/S: Anxiety, dizzy, tingly/spasms of hands/feet, chest pain, ↑RR +↑HR

Tx: Calm, coach breathing

43
Q

Respiratory & Cardiac: Angina

A

MOI: Chest pain brought on by physical or emotional stress that is relieved by rest and medication

Tx: Rest and monitor. First timers slow walk to the car

44
Q

Respiratory & Cardiac: Heart Attack

A

MOI: Hypoxia (lack of oxygen) leading to muscle damage

S/S Classic: crushing chest pain, arm/jaw pain radiating, SPCC, N/V, dizzy, anxious, history/risk factors

S/S Women/Seniors/Diabetics: Shortness of breath w/o pain, heartburn, fainting, weakness, N/V, Altered mental state

Tx: Rest, Calm, CHEW 325mg ASA, Request oxygen. Evacuate.

Rx: Nitroglycerin IF → Rx + Systolic BP ↑100 + NO Rx erectile dysfunction → Wait 5 min → IF Pain>0, Dose. Three dose MAX

Kate’s Classes (6 decks)

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